Tuition Fee Loan application form

Tuition Fee Loan application form for new part-time EU students 2015/16 About this form Who should complete this form? Complete this form if you re: a part-time European Union (EU) student studying in England and you started your course on or after 1 September 2012 An EU Open University student resident in England and your course started on or after 1 September 2012 For more information about student finance visit www.gov.uk/studentfinance 1 your personal details 1.1 Customer Reference Number i (if you have one) Where you see this icon it means there are notes in the accompanying Tuition Fee Loan application notes to help you. i Please read the accompanying notes The Tuition Fee Loan application notes will give you detailed guidance and help you to complete this form. What sections should you complete? All students complete sections 1 to 6. Make sure you read, sign and date the declaration. Only students applying for a bursary should complete section 7. 1.2 Personal details Complete these details exactly as stated on your passport or ID card If your name has changed from your passport or ID card then give supporting evidence confirming the change. Give a note of any other previous names you've had on the additional notes pages at the back of this form. e Where you see this icon it means we need you to give supporting evidence. You can find details in the accompanying notes. e Title Mr Mrs Miss Ms Forename(s) Surname/family name Gender Male Female Date of birth Country of birth Place of birth (the name of the town or village) Nationality /A

1 your personal details - continued 1.3 Do you have a National Insurance number? i Yes - if so, write it here 1.4 Contact details Full home address Give your current home address. Include the street name, town/city and country. Give your term-time address if you know it. If you give a term-time address then we ll send correspondence to that address. You can update your address(es) at any time by logging into your online account or contacting us. Full term-time address Postcode Date you ll move to your term-time address Home phone number Mobile phone number Email address 2 of 17

2 previous support and qualification history 2.1 Will you be getting funding from any other source to meet the costs of your tuition fee in this academic year? Yes - give details Tell us about any contribution to your tuition fees that may be made by an employer, a bursary scheme, or from any other type of fund or sponsorship. 2.2 Have you ever had any other loans from the Student Loans Company (SLC)? - go to 2.3 Yes - are you behind with the repayments? Yes - you can t apply for student finance until you resolve this. If you have any Mortgage Style (MS) Loans please call your debt owner. If you do not know who your debt owner is please call 0141 243 3697 for advice. If you have an Income Contingent Repayment (ICR) loan call 0141 243 3970. 3 of 17

2 previous support and qualification history - continued 2.3 Have you started any undergraduate or postgraduate course of higher education in any country since leaving school? i 2.4 Do you have Qualified Teacher Status? - go to 3.1 Yes - go to 2.5 and complete the tables with details of your previous study Yes - are you: recognised as a qualified teacher because you ve been registered by the Institute for Learning as holding Qualified Teacher Learning and Skills status (QTLS) You may be eligible for support - go to 2.5 recognised as a qualified teacher and have been issued with a Qualified Teacher Status (QTS) certificate You will not qualify for a part-time Tuition Fee Loan. Don t continue with this application. 4 of 17

2 previous support and qualification history - continued 2.5 Complete this table with your previous course details. Mention all full-time (FT), part-time (PT) and full-time distance learning (DL) courses you ve studied. Course Course title and qualification (for example, BA English Honours) Name and address of university or college (including town and country) FT/PT/ DL Start Date End Date 1 MM YYYY MM YYYY 2 3 4 2.5.1 Did you achieve a qualification for the course(s) you ve listed in 2.5? If you entered a course in field 1 of 2.5, use field 1 to give us information about the same course in the tables in 2.5.1 and 2.5.2. Course Qualification achieved 1 2 3 4 Yes Yes Yes Yes 2.5.2 Did you receive funding from Student Loans Company (SLC) for the course(s) you ve listed in 2.5? Course Funding received If, did you apply for funding?i 1 Yes Yes 2 Yes Yes 3 Yes Yes 4 Yes Yes 5 of 17

3 residence 3.1 Are you an EU national? 3.2 Are you the family member of an EU national? Yes - send evidence e - go to 3.3 Yes - give details of your relationship to the family member for example, mother - send evidence e! If you have answered to both of the above questions you can t apply for student finance on this form. Don t continue with this application. Visit www.gov.uk/studentfinance for more information on student finance. 3.3 Give details of your residence for the three years prior to the start of the first academic year of your course. i Full address You must provide the full address (including building name and/or number, street name, town, region, postcode and country), exact dates you lived there and why you were there. Make sure you give full details for the three years prior to the start of the first academic year of your course. If you leave any gaps your application may be delayed until we get the information we need. For example, if your course begins 28/09/2015 we need your residence details for the period 01/09/2012-01/09/2015. From To Why were you there? 6 of 17

3 residence - continued Full address From To Why were you there? 3.4 At any time since 1 September 2012 has: either of your parents, step-parents, guardians; or your husband, wife, civil partner lived or worked outside the EEA or Switzerland? Make sure you give full details. If you leave any gaps your application may be delayed until we get the information we need. Yes - give details Full address From To Why were they there? 7 of 17

3 residence - continued Full address From To Why were they there? If you need further space use the additional notes page at the back of this form. 8 of 17

4 about your university or college and course 4.1 University or college details If your course is at a university that is made up of a number of colleges, give the name of the college first, followed by the name of the university (for example, Birkbeck, Central London campus, University of London). Name Address Postcode 4.1.1 Give the name of your course You should check the name of your course with your university or college. If the course details you give us can t be confirmed yet, your student funding may be delayed. 4.2 Qualification you expect to gain (for example, BA (Hons) English) 4.3 In this academic year, when will you start your studies? MONTH - YEAR 4.4 When will you finish the last year of your course? MONTH - YEAR 4.5 Are you entering your first year of study? Yes - go to 4.8 4.6 Which year of your studies are you going into? Make sure you tell us what year of your studies you are going into not the year of your course. 4.7 What date did you start your studies? MONTH - YEAR 4.8 Full tuition fee amount your university or college is charging you this academic year? i 9 of 17

5 your loan request 5.1 Tell us the amount of Tuition Fee Loan you want to borrow i Tuition Fee Loans help to cover the costs of tuition fees charged by a university or college. Any Tuition Fee Loan you borrow will be paid directly to your university or college. Maximum available to you (tick box) Less than maximum available to you (enter amount) 5.2 Contact details Give the names and addresses of two contacts. The people you name should live at different addresses and will only be contacted if, for example, you move address and don t inform us. You must inform these people that you ve named them as contacts. Contact 1 Forename(s) Surname Relationship to you Full Address Postcode Home phone number Contact 2 Forename(s) Surname Relationship to you Full Address Postcode Home phone number 10 of 17

6 declaration Before signing and returning your completed form, you should read the Data Protection Statement in the accompanying notes. i By signing this declaration you are confirming that you have read the terms and conditions about the Tuition Fee Loan because they will affect you if you apply for the loan at any time in academic year 2015/16. If you don t apply for the Tuition Fee Loan in 2015/16 the terms and conditions will not affect you. Your application for financial support may be delayed unless you sign and date this declaration. I confirm that to the best of my knowledge and belief, the information I have given on this form is true and complete and I understand that if I have given the Student Loans Company false information, or have not given them complete information, I may not receive financial support, any support I have received may be withdrawn and I could be prosecuted. I agree to give the Student Loans Company any additional information they require to enable them to process my application and agree to tell them immediately if my circumstances change in any way that might affect my entitlement to financial support. I understand that if I do not tell the Student Loans Company about any change in my circumstances, which may affect my entitlement, I may not be eligible to receive any outstanding instalments or payments that they have told me about, and that I may have to repay all or part of the financial support I have already received in the year. te: The term the lender means the Secretary of State for Education. I declare that: a I acknowledge and agree that any loan(s) made to me by the lender (which includes any persons exercising functions on behalf of the Secretary of State pursuant to section 23(4) of the Teaching and Higher Education Act 1998 as amended from time to time or successor legislation, the Act ) will be on the terms set out in these declarations and in Regulations which are made under section 22 of the Act as amended from time to time. b If I breach any of the terms under which any loan(s) will be made, I agree that I will be obliged to pay any charges and penalties which may apply under the Teaching and Higher Education Act 1998 and the Regulations made under that Act, as amended c from time to time or successor legislation and/or Regulations. I acknowledge and agree that in the event that I have: (i) reached the age of 18 years; and (ii) have entered into one or more agreements for a loan under section 22 of the Teaching and Higher Education Act 1998 (and relative secondary legislation) before I reached the age of 18 years, upon signing this declaration I am agreeing to ratify any and all such student loans. I understand that ratification of any agreement for a loan made with me before I reached the age of 18 years is a statutory precondition of my eligibility for student support after attaining the age of 18 years. d I agree to take all future action requested by the lender and provide the lender with all information required to ensure repayment, in accordance with the Regulations referred to in paragraph a. e I agree that from the date I submit this form until the date when my loan(s), together with all and any interest, penalties and charges which apply, is fully repaid I will notify the lender of any changes in the personal details (including National Insurance number) and contact details I have provided as required in accordance with the Regulations referred to in paragraph a. f In the event that I leave the United Kingdom to reside outside the United Kingdom or that for any other reason I am outside the UK tax system, I undertake to inform the lender in accordance with the Regulations referred to in paragraph a and I undertake to provide the lender with my new and any subsequent contact details until my loan, together with all and any interest, penalties and charges which apply, is fully repaid. g The particulars I have given in this form are correct. h I have read and understood the terms and conditions guide available online at www.gov.uk/studentfinance i j I undertake to repay the lender any loan(s) made to me, together with all and any interest, penalties and charges which apply. I agree that any loan(s) made to me as a consequence of the acceptance of my application is/ are contract(s) between me and the lender which binds me from the payment to me of the first loan advance and that the repayment of any such loan(s), together with all and any interest, penalties and charges which apply, will be due by me to the lender as a debt. 11 of 17

k I agree that I shall be obliged to make repayment of my loan(s), together with all and any interest, penalties and charges which apply, to such address as shall be notified to me in writing and that any services in respect of my loan(s) may be provided at such address or other address(es) as the lender may from time to time determine and that the service of providing the loan is provided at the lender s principal address. l I agree that any action for repayment and/or in respect of or in connection with my loan(s) and/or all and any interest, penalties and charges which apply, will be brought before the ordinary civil courts and shall be governed by the general rules of civil procedure. m I agree that my request for a loan, the loan and the contract between me and the lender shall be governed by the law of the place of my course of study as stated in this form EUPTL1. n I irrevocably agree that the courts of the part of the United Kingdom in which my place of study is situated shall have non-exclusive jurisdiction to hear any action or proceedings arising out of or in connection with the loan and the contract between me and the lender and I irrevocably submit to the jurisdiction of those courts and waive any objection to the jurisdiction of those courts, provided that this shall not limit the lender s rights to take proceedings against me in any other court of competent jurisdiction. o I understand that the Student Loans Company will check my National Insurance number and personal details with the Department for Work and Pensions (DWP). If I do not know my National Insurance number, or if the number I provide cannot be authenticated, DWP will trace and give my number to the lender. p If I have broken the terms of this contract I agree that the lender may share information held about me and my account with any person, including the government or a government agency of another country, who may assist in establishing my whereabouts and/or in taking action to recover outstanding loan amounts. Your full name (in BLOCK CAPITALS) DfE Your signature Today s date 2 0 12 of 17

7 bursary consent You may be eligible for a bursary or scholarship from your university or college. Contact them to find out more about any bursaries or scholarships they may be offering. Your university or college will ask for some information about you and your application* to decide if you are eligible for a non-repayable bursary or scholarship. Your decision about bursary and scholarship data sharing will not affect your entitlement to any other financial support available. We will automatically share your information with your university or college so they can work out if you are eligible for these awards. If you don t want your details to be shared for this purpose, please tick this box Most universities and colleges won t pay bursaries or scholarships if you don t give consent to share your information. *To help your university or college administer these awards (i.e. to determine eligibility and entitlement to, and if relevant pay, a bursary or scholarship bursary administration purposes ) the Secretary of State or Student Loans Company will share some of the personal and course details you have given in connection with this application for student finance (whether on this form or at a later date). Information about your eligibility for student finance will also be shared. 13 of 17

checklist Before you send back your form, remember to: >>>>>>ascasc<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< >>>>>>ascasc<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< Include either your original or a certified copy of your passport or ID card. If you don t, we can t give you a loan. If you re sending a certified copy make sure you also return the completed certifier checklist on the next page. Tick??? Tell us how much loan you want on page 10 You need to tell us how much you want to borrow. If you don t we can t give you a loan. If you re not sure how much your university or college is charging you, check with them before you send back your form. Sign the declaration on page 12 Once you ve printed the form, sign the declaration. Without your signature, we can t give you a loan. Tick Tick Return your completed form to: Student Finance Services Student Loans Company PO Box 89 Darlington County Durham England United Kingdom DL1 9AZ Make sure to pay the correct postage or your form won t get to us. 14 of 17

certifier checklist Complete this form and return with your certified evidence items. Personal details Customer Reference number (if you have one) Forename(s) Surname(s) UK National Insurance number (if you have one) A certified copy is a photocopy of an original document which must have been stamped, signed and dated as being a true copy of the original by a person of good standing in the community. The person certifying evidence must not be a relative. Examples of a person of good standing include: a bank or building society official, civil servant, minister of religion, police officer, someone with a professional qualification i.e. teacher, accountant, engineer, solicitor, etc. Make sure the person certifying your document(s) stamp and sign all pieces of evidence Certifier information This section must be fully completed and stamped before being returned with any evidence. Name (in BLOCK CAPITALS) Job title/occupation Email address Telephone number (including international dialling code) Signature Today s date Address of certifier Official stamp 15 of 17

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additional notes If you re providing extra information clearly mark what section and question the information is about. 17 of 17